Evolution of Reproductive Disorders Related to Celiac Disease Under Glutenfree Diet

Abstract

Introduction: Celiac disease is an autoimmune enteropathy induced by the ingestion of gluten (wheat, barley, rye). The classical form has become a minority. Currently, the most frequent forms of presentation are extraintestinal with various manifestations, among others, reproductive disorders. The aim of our study is to assess the frequency of these disorders in celiac disease and their evolution under gluten-free diet. Materials and methods: Descriptive retrospective study of 173 patients with celiac disease followed in the department of diseases of the digestive tract "Medecine C" of the Ibn Sina Hospital in Rabat, over a period of 18 years. Result: In 173 patients with celiac disease, 58 patients (28.9%) had reproductive disorders. There are 53 women and 5 men. The average age was 25-32 years. The diagnosis of celiac disease is based on histology and serology. The reproductive problems were never isolated but always associated with other digestive or extra-intestinal signs at the time of diagnosis of celiac disease. These disorders are represented by: delayed puberty in 11 cases (19%), secondary amenorrhea in 13 cases (22.4%), irregular menstrual in 12 cases (20.6%), absence of development of secondary sex characteristics in 8 cases (12.5%), spontaneous abortions in 7 cases (10.9%), menometrorrhagia in 4 cases (13.8%), primary sterility in 5 cases (8.6%), early menopause in 6 cases (10.3%), premature delivery in 3 cases (5%), primary amenorrhea in 2 cases (3.4%) and intrauterine fetal death in one case (1.7%). All our patients have had a gluten-free diet. 15 patients lost to follow-up, two patients died and 12 patients undergoing follow-up. The remaining 29 patients, the evolution of reproductive disorders under gluten-free diet was favourable in 26 cases (90%), with the normalization of cycles in 15 cases, resumption of cycles in 6 cases, development of secondary sex characteristics in 2 cases, fertility resumption in one case, initiation of cycles after primary amenorrhea in one case and delivery of a new-born at term after premature deliveries in one case. The evolution was unfavourable in 3 cases with the notion of miscarriage 4 years after the start of the gluten-free diet in one patient and the absence of cycle resumption in two cases. Conclusion: The reproductive disorders associated with celiac disease are frequent and varied. In our study, these disorders responded very well under a gluten-free diet, conducted in 90% of cases. These disorders are thus reversible under this diet.